Abstract
Rapidly progressing relapsed/refractory multiple myeloma (RRMM) patients with compromised marrow have limited treatment options. Thus, non-myeloablative chemotherapy with a stem cell boost (SCB) may provide disease control and hematopoietic improvement as bridge to subsequent therapies. We identified 96 patients who received a SCB between January 2011 and December 2019 at the Mount Sinai Hospital. Patients had a median age of 64 years, received a median of 7 prior lines of therapy and 68 and 42% were triple-class and penta-drug refractory, respectively. Chemotherapy included melphalan (MEL) (n = 16), melphalan + carmustine (BCNU/MEL) (n = 52) or a variant of DCEP (dexamethasone, cyclophosphamide, etoposide, cisplatin) (n = 28). Median time to neutrophil recovery was 10 days and was significantly lower with DCEP (8 days) compared to MEL and BCNU/MEL (10–11 days) (p = 0.0047). Time to progression, progression-free survival and overall survival were 3.19, 2.7 and 8.38 months, respectively. The BCNU/MEL group had the highest response rate of 85% (p = 0.05), clinical benefit rate of 94% (p = 0.0014), progression-free survival of 3.3 months (p = 0.4) and overall survival of 8.7 months (p = 0.5). Sixty-six patients (69%) were bridged to new lines of therapy, including clinical trials. Non-myeloablative chemotherapy with SCB provides rapid disease control and marrow recovery with potential to receive further therapy.
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Data availability
The datasets generated during and analysed during the current study are available in the FigShare repository, [https://doi.org/10.6084/m9.figshare.21286503].
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Conceptualization: THM and JR; Methodology: EM; Investigation: THM, ST, BP, MR, RJ and AS; Writing – Original Draft: THM; Writing – Review & Editing: all authors; Resources: JR; Supervision: JR.
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THM received advisory board fees from Legend Biotech. LS received consulting fees from Takeda. SR received honoraria from Karyopharm and Janssen, and advisory board fees from Karyopharm and Celgene/Bristol Myers Squibb, and research support from Janssen, Celgene/Bristol Myers Squibb, C4 Therapeutics. AR received advisory board fees from Celgene/Bristol Myers Squibb, Janssen, Sanofi, and GlaxoSmithKline. HJC is an employee of the Multiple Myeloma Research Foundation, and received research funding from Celgene/Bristol Myers Squibb, and Takeda. CR received consulting fees from Janssen, Artica, Takeda, Amgen, Karyopham, and Caelum Biosciences. SP received advisory board fees from GRAIL and research support from Celgene/Bristol Myers Squibb, Amgen, and Karyopharm. A.C. received consulting fees from Amgen, Celgene/Bristol Myers Squibb, Janssen, Karyopharm, and Takeda, and advisory board fees from Amgen, Celgene/Bristol Myers Squibb, Janssen, Karyopharm, Takeda, Sanofi, and Seattle Genetics, and research support from Amgen, Array Biopharma, Celgene/Bristol Myers Squibb, GlaxoSmithKline, Janssen, Takeda, Novartis, Oncoceutics, Pharmacyclics and Seattle Genetics. SJ received advisory board fees and consulting fees from Celgene/Bristol Myers Squibb, Janssen, Legend Biotech, Karyopharm, Sanofi and Takeda. J.R. received speaking fees from Celgene/Bristol Myers Squibb, Sanofi, and Janssen, and advisory board fees from Celgene/Bristol Myers Squibb, Janssen, Celgene/Bristol Myers Squibb, Karyopharm, Sanofi, X4 Pharmaceuticals, Oncopeptides, Adaptive Biotechnologies, Secura Bio, Astrazeneca, and Takeda, and consulting fees from Celgene/Bristol Myers Squibb, Secura Bio, and Oncopeptides. EM, ST, BP, MR, RJ, and AS declare no potential conflict of interest.
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Mouhieddine, T.H., Moshier, E., Thibaud, S. et al. Bridging advanced myeloma patients to subsequent treatments and clinical trials with classical chemotherapy and stem cell support. Bone Marrow Transplant 58, 80–86 (2023). https://doi.org/10.1038/s41409-022-01848-7
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DOI: https://doi.org/10.1038/s41409-022-01848-7